The main symptoms of Gilles de la Tourette syndrome (GTS) are motor and vocal tics, but there are also several psychiatric disturbances such as obsessive compulsive symptoms (OCD) and mutilations. The etiology and pathophysiology of this basal ganglia disorder are unknown. Though many patients benefit from therapy with dopamine antagonists, the effect is often insufficient. Therapeutic efficacy of the opiate antagonist naltrexone has been described in recent years. Ten patients (three f, seven m) with GTS were invesitgated in a seven-week, open dose-response trial, using naltrexone in doses ranging from 12.5 mg to 200 mg/day. The severity of the GTS symptoms were rated with the Yale Global Tic Severity Scale (YGTSS) and the Tourette Syndrome Global Scale (TSGS); OCD was estimated by the Maudsley Obsessive Compulsive Inventory (MOCI). The course of tics and psychopathology was assessed by three self-report scales, and two scales rated by clinicians (Clinical Global Impression, CGI; Brief Psychiatric Rating Scale, BPRS). Only two patients showed improvement of the GTS. In four patients, no effect was observed, whereas the other four patients exhibited deterioration. One patient finished the complete trial, three patients dropped out because of lack of improvement, and four because of deterioration of the symptoms. Considering the mean values, no improvement of GTS could therefore be observed, and because of the unpredictable effect, the study was stopped after ten patients. Nevertheless, the effects were quite controversial. The opiate system seems to be affected only in some of the GTS patients in a clinically relevant manner, and opiate antogonists can either improve or provoke GTS symptoms. Pathophysiologically different subgroups of GTS may contribute to the controversal results.

Neuropsychological deficits in Tourette's syndrome (TS) may be associated with learning disabilities. We examined the neuropsychological performance of 70 children with TS between the ages of 6 and 18 years who were classified into four groups based on their pattern of performance on the Wide Range Achievement Test-Revised. The groups included three learning disability subtypes and a nonlearning disabled comparison group. The groups differed significantly on several measures in a comprehensive neuropsychological test battery. The pattern of differences was not entirely consistent with previous research, however, suggesting that the neuropsychological correlates of learning disabilities may be influenced by the specific pathophysiology associated with TS. Thus, previous research on the neuropsychology of learning disability subtypes might not be generalizable to children with discrete neuropsychiatric disorders such as TS. (JINS, 1996, 2, 375–382.)

Objective: To identify similarities and differences in neuropsychiatric correlates in children with Tourette's syndrome (TS) and those with ADHD. Method: The sample consisted of children with Tourette's syndrome with ADHD(N=79), children with Tourette's syndrome without ADHD (N=18), children with ADHD (N=563), psychiatrically referred children (N=212), and healthy controls (N=140). Results: Disorders specifically associated with Tourette's syndrome were obsessive compulsive disorder (OCD) and simple phobias. Rates of other disorders, including other disruptive behavioral, mood, and anxiety disorders, neuropsychologic correlates, and social and school functioning were indistinguishable in children with Tourette's and ADHD. However, children with Tourette's syndrome plus ADHD had more additional comorbid disorders overall and lower psychosocial function than children with ADHD. Conclusions: These findings confirm previously noted associations between Tourette's syndrome and OCDbut suggest that disruptive behavioral, mood, and anxiety disorders as well as cognitive dysfunctions may be accounted for by comorbidity with ADHD. However, Tourette's syndrome plus ADHD appears to be a more severe condition than ADHD alone.